Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.

Mapeamento das projeções retinianas para o sistema óptico acessório, colículo superior e complexo pré-tectal do sagui (callithrix jacchus)

The accessory optical system, the pretectal complex, and superior colliculus are important control centers in a variety of eye movement, being extremely necessary for image formation, consequently to visual perception. The accessory optical system is constituted by the nuclei: dorsal terminal nucleus, lateral terminal nucleus, medial terminal nucleus and interstitial nucleus of the posterior superior fasciculus. From a functional point of view they contribute to the image stabilization, participating in the visuomotor activity where all system cells respond to slow eye movements and visual stimuli, which is important for the proper functioning of other visual systems. The pretectal complex comprises a group of nuclei situated in mesodiencephalic transition, they are: anterior pretectal nucleus, posterior pretectal nucleus, medial pretectal nucleus, olivary pretectal nucleus and the nucleus of the optic tract, all retinal projection recipients and functionally are related to the route of the pupillary light reflex and the optokinetic nystagmus. The superior colliculus is an important subcortical visual station formed by layers and has an important functional role in the control of eye movements and head in response to multisensory stimuli. Our aim was to make a mapping of retinal projections that focus on accessory optical system, the nuclei of pretectal complex and the superior colliculus, searching mainly for pretectal complex, better delineation of these structures through the anterograde tracing with the B subunit of cholera toxin (CTb) followed by immunohistochemistry and characterized (measured diameter) synaptic buttons present on the fibers / terminals of the nucleus complex pré-tectal. In our results accessory optical system, including a region which appears to be medial terminal nucleus and superior colliculus, were strongly marked by fibers / terminals immunoreactive CTb as well as pretectal complex in the nucleus: optic tract, olivary pretectal nucleus, anterior pretectal nucleus and posterior pretectal nucleus. According to the characterization of the buttons it was possible to make a better definition of these nucleus.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Receptores de citocinas proinflamatórias na pré-eclâmpsia

Preeclampsia is a disease specific of human pregnancy that affects 3-8% of pregnant women, and it is one of the three leading causes of maternal mortality and morbidity. The disease is characterized by hypertension and proteinuria after the 20th week of gestation. The risk factors for this disease are not completely understood but appear to include dysregulation of the immune response arising from defects in placentation, environmental and genetic factors. This study aimed to determine whether the variation in the amount of proinflammatory cytokine receptors IL-1R2, IL-6R and TNF-αR1 would be involved in preeclampsia. They were recruited women with preeclampsia (n=24) and women who evolved during pregnancy without changes in blood pressure (n=12) were recruited. Clinical and laboratory data were collected. The cytokine receptors (IL-1R2, TNF-αR1 and IL-6R) were assessed in mononuclear cells isolated from peripheral blood using flow cytometry (Control = 8; PE = 24). C-reactive protein (CRP) was determined by CRP ultrasensitive method (Control = 7; PE = 18) was performed using sera pregnant women. Women with preeclampsia had higher weight at the beginning of the pregnancy (p=0.0171) and lower gestational age at delivery (0.0008). Classical monocytes were decreased in preeclampsia but not intermediate or non-classical monocytes. The frequency of IL-1R2 pro inflammatory cytokine receptors is decreased in women with PE only in the subpopulation of non-classical monocytes (p = 0.0011). TNF-αR1 receptor and IL-6R, had a decreased frequency in the three subpopulations of monocyte (classic, intermediate and non-classical) when compared to women with normal pregnancy. An increase in IL-1R2 receptor in TCD4+ lymphocytes, but a decrease in TNF-receptor and IL-6R in women with preeclampsia were found. No differences in the frequency of those receptors in CD3+/CD8+ in preeclampsia. There was no difference in C-reactive protein in preeclampsia. The reduction in the amount of IL-1R2, TNF- αR1 and IL-6R monocytes and lymphocytes can be involved in the regulation of inflammation observed in preeclampsia, contributing to disease.

Avaliação da influência de surfactantes químico e biológico na hidrólise enzimática de casca de coco verde após pré-tratamento ácido/alcalino e com peróxido de hidrogênio alcalino

In Brazil many types of bioproducts and agroindustrial waste are generated currently, such as cacashew apple bagasse and coconut husk, for example. The final disposal of these wastes causes serious environmental issues. In this sense, waste lignocellulosic content, as the shell of the coconut is a renewable and abundant raw material in which its use has an increased interest mainly for the 2nd generation ethanol production. The hydrolysis of cellulose to reducing sugars such as glucose and xylose is catalysed by a group of enzymes called cellulases. However, the main bottleneck in the enzymatic hydrolysis of cellulose is the significant deactivation of the enzyme that shows irreversible adsorption mechanism leading to reduction of the cellulose adsorption onto cellulose. Studies have shown that the use of surfactants can modify the surface property of the cellulose therefore minimizing the irreversible binding. The main objective of the present study was to evaluate the influence of chemical and biological surfactants during the hydrolysis of coconut husk which was subjected to two pre-treatment in order to improve the accessibility of the enzymes to the cellulose, removing this way, part of the lignin and hemicellulose present in the structure of the material. The pre-treatments applied to coconut bagasse were: Acid/Alkaline using 0.6M H2SO4 followed by 1M NaOH, and the one with Alkaline Hydrogen Peroxide at a concentration of 7.35% (v/v) and pH 11.5. Both the material no treatment and pretreated were characterized using analysis of diffraction X-ray (XRD), Scanning Electron Microscopy (SEM) and methods established by NREL. The influence of both surfactants, chemical and biological, was used at concentrations below the critical micelle concentration (CMC), and the concentrations equal to the CMC. The application of pre-treatment with coconut residue was efficient for the conversion to glucose, as well as for the production of total reducing sugars, it was possible to observe that the pretreatment fragmented the structure as well as disordered the fibers. Regarding XRD analysis, a significant increase in crystallinity index was observed for pretreated bagasse acid/alkali (51.1%) compared to the no treatment (31.7%), while that for that treated with PHA, the crystallinity index was slightly lower, around 29%. In terms of total reducing sugars it was not possible to observe a significant difference between the hydrolysis carried out without the use of surfactant compared to the addition of Triton and rhamnolipid. However, by observing the conversions achieved during the hydrolysis, it was noted that the best conversion was using the rhamnolipíd for the husk pretreated with acid/alkali, reaching a value of 33%, whereas using Triton the higher conversion was 23.8%. The coconut husk is a residue which can present a high potential to the 2nd generation ethanol production, being the rhamonolipid a very efficient biosurfactant for use as an adjuvant in the enzymatic process in order to act on the material structure reducing its recalcitrance and therefore improving the conditions of access for enzymes to the substrate increasing thus the conversion of cellulose to glucose.

Avaliação da influência de surfactantes químico e biológico na hidrólise enzimática de casca de coco verde após pré-tratamento ácido/alcalino e com peróxido de hidrogênio alcalino

In Brazil many types of bioproducts and agroindustrial waste are generated currently, such as cacashew apple bagasse and coconut husk, for example. The final disposal of these wastes causes serious environmental issues. In this sense, waste lignocellulosic content, as the shell of the coconut is a renewable and abundant raw material in which its use has an increased interest mainly for the 2nd generation ethanol production. The hydrolysis of cellulose to reducing sugars such as glucose and xylose is catalysed by a group of enzymes called cellulases. However, the main bottleneck in the enzymatic hydrolysis of cellulose is the significant deactivation of the enzyme that shows irreversible adsorption mechanism leading to reduction of the cellulose adsorption onto cellulose. Studies have shown that the use of surfactants can modify the surface property of the cellulose therefore minimizing the irreversible binding. The main objective of the present study was to evaluate the influence of chemical and biological surfactants during the hydrolysis of coconut husk which was subjected to two pre-treatment in order to improve the accessibility of the enzymes to the cellulose, removing this way, part of the lignin and hemicellulose present in the structure of the material. The pre-treatments applied to coconut bagasse were: Acid/Alkaline using 0.6M H2SO4 followed by 1M NaOH, and the one with Alkaline Hydrogen Peroxide at a concentration of 7.35% (v/v) and pH 11.5. Both the material no treatment and pretreated were characterized using analysis of diffraction X-ray (XRD), Scanning Electron Microscopy (SEM) and methods established by NREL. The influence of both surfactants, chemical and biological, was used at concentrations below the critical micelle concentration (CMC), and the concentrations equal to the CMC. The application of pre-treatment with coconut residue was efficient for the conversion to glucose, as well as for the production of total reducing sugars, it was possible to observe that the pretreatment fragmented the structure as well as disordered the fibers. Regarding XRD analysis, a significant increase in crystallinity index was observed for pretreated bagasse acid/alkali (51.1%) compared to the no treatment (31.7%), while that for that treated with PHA, the crystallinity index was slightly lower, around 29%. In terms of total reducing sugars it was not possible to observe a significant difference between the hydrolysis carried out without the use of surfactant compared to the addition of Triton and rhamnolipid. However, by observing the conversions achieved during the hydrolysis, it was noted that the best conversion was using the rhamnolipíd for the husk pretreated with acid/alkali, reaching a value of 33%, whereas using Triton the higher conversion was 23.8%. The coconut husk is a residue which can present a high potential to the 2nd generation ethanol production, being the rhamonolipid a very efficient biosurfactant for use as an adjuvant in the enzymatic process in order to act on the material structure reducing its recalcitrance and therefore improving the conditions of access for enzymes to the substrate increasing thus the conversion of cellulose to glucose.

Estudo da injeção de água e gás em um reservatório com características do pré-sal brasileiro

The pre-salt province is composed by large amounts of light oil and with good quality, a reality that puts Brazil in a strategic position facing the great demand for energy worldwide. In this province are the largest discoveries in the world in the last ten years; areas as Libra, Franco and Lula field, everyone containing volumes greater than 8 billion recoverable oil barrels. To develop and optimize the production of these fields, a study was done for choosing the improved oil recovery methods. The main motivations were the presence of carbon dioxide (CO2) as a contaminant and the strategic decision of do not discard it, combined with high GOR (gas-oil ratio) of the reservoir fluid. The method should take advantage of the unique abundant resources: seawater and produced gas. This way, the process of matching these resources in the water alterning gas injection (WAG) became a good option. In this master’s dissertation, it was developed a reservoir model with average characteristics of the Brazilian pre-salt, where was applied the improved oil recovery method of water alternating gas. The production of this reservoir was analyzed by parameters as: the first fluid injected in the injection process, position of the injection wells completion, injection water and gas rate and cycle time. The results showed a good performance of the method, with up to 26% of gains in the recovery factor regarding the primary recovery, since the application of water injection and gas, individually, was not able to overcome 10 % of gain. The most influential parameter found in the results was the cycle time, with higher recovery factor values obtained with the use of shorter times.

Trajetórias e fatores associados a qualidade de vida de mães de recém-nascidos pré-termos de muito baixo peso até três anos após o parto

Preterm birth is a public health problem worldwide. It holds growing global incidence rates, high mortality rates and a risk of the long-term sequelae in the newborn. It is also poses burden on the family and society. Mothers of very low birth weight (VLBW) preterm infants may develop psychological disorders, and impaired quality of life (QoL). Factors related to mothers and children in the postpartum period may be negatively associated with the QoL of these mothers. The aim of this study was to assess factors possibly associated with the QoL of mothers of VLBW preterm newborns during the first three years after birth. Mothers of VLBW preterm answered the World Health Organization Quality of Life (WHOQOL)-bref and the Beck Depression Inventory (BDI) in five time points up to 36 months postpartum, totalizing 260 observations. The WHOQOL–bref scores were compared and correlated with sociodemographic and clinical variables of mothers and children at discharge (T0) and at six (T1), twelve (T2), 24 (T3) and 36 (T4) months after the delivery. We used the Kruskal Wallis test to compared scores across different time points and correlated WHOQOL-bref scores with the sociodemographic and clinical variables of mothers and preterm infants. Multiple linear regression models were used to evaluate the contribution of these variables for the QoL of mothers. The WHOQOL–bref scores at T1 and T2 were higher when compared to scores in T0 in the physical health dimension (p = 0.013). BDI scores were also higher at T1 and T2 than those at T0 (p = 0.027). Among the maternal variables that contributed most to the QoL of mothers, there were: at T0, stable marital union (b= 13.60; p= 0.000) on the social relationships dimension, gestational age (b= 2.38; p= 0.010) in the physical health dimension; post-hemorrhagic hydrocephalus (b= -10.05; p= 0.010; b= -12.18; p= 0.013, respectively) in the psychological dimension; at T1 and T2, Bronchopulmonary dysplasia (b= -7.41; p= 0.005) and female sex (b= 8,094; p= 0.011) in the physical health dimension and environment, respectively. At T3, family income (b= -12.75’ p= 0.001) in the environment dimension, the SNAPPE neonatal severity score (b= -0.23; p= 0.027) on the social relationships dimension; at the T4, evangelical religion (b= 8.11; p= 0.019) and post-hemorrhagic hydrocephalus (b: -18.84 p: 0.001) on the social relationships dimension. The BDI scores were negatively associated with WHOQOL scores in all dimensions and at all times points: (-1.42 ≤ b ≤ -0.36; T0, T1, T2, T3 and T4). We conclude that mothers of preterm infants VLBW tend to have a transient improvement in the physical well-being during the first postpartum year. Their quality of life seems to return to levels at discharge between two and three years after delivery. The presence of maternal depressive symptoms and diagnosis of post-hemorrhagic hydrocephalus or BDP are factors negatively associated with the QoL of mothers. Social, religious and economic variables are positively associated with the QoL of mothers of VLBW preterm.

Fatores pré-abate que influenciam na qualidade da carne de frangos griller

The consumption of a product is directly linked to its quality, and are required to comply with quality standard regulations. In chicken "griller" which comes from industrial strains, selected for best growth performance, shot with up to 35 days old and weighing 1,400kg, they have not been reported in the literature a number of quality aspects This study aimed determine the muscle transformation time in the flesh in chickens "griller" incidence of meat defects, "PSE" (pale, soft and exdudative) and "DFD" (dark, firm and dry) and their correlation between different window times slaughter (total time between beginning of the fasting and the time of slaughter) and pH curve, four different times post mortem. The base data for the study was composed of information of 208 chickens, collected between August and September 2014, in a slaughterhouse slaughtering chickens in the middle region of Triangulo Mineiro and Alto Paranaíba. We used the Minitab 17.1.0 program for the development of descriptive statistical analysis and Pareto charts. The Pearson correlation was used to evaluate the linear relationship between two variables and Excel 2013, Microsoft Office®, to produce tables and graphs. The analysis consisted of 11 chickens cities and the distance to the poultry slaughterhouse ranged from 24.5 km to 123 km. It was observed that the pH curve decays gradually until time 5horas after slaughter, and its increase was 24, indicating the transformation of the muscle meat. The incidence of regular meat was 39.9%, "DFD" 30.3% and "PSE" 29.8%. For "DFD" meat, it was observed that factors: low ambient temperature, longer transportation and fast window and mileage at dirt road, contributed to its occurrence (p <0.05). For "PSE" meat, it was observed that lower body weight factors, longer transport favored frequency (p <0.05) of the meat defect. There was no significant correlation in variance analysis between distance, waiting time at rest shed and humidity related to meat defects (p> 0.05). This high incidence of defects meat may be due to pre-slaughter stress factors.

La inclusión masiva de tecnologías digitales en el ámbito escolar : Un estudio comparativo de la apropiación de TIC por estudiantes de clases populares y clases medias en el marco del Programa Conectar Igualdad en el Gran La Plata

Fil: Benítez Larghi, Sebastián. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

La inclusión masiva de tecnologías digitales en el ámbito escolar : Un estudio comparativo de la apropiación de TIC por estudiantes de clases populares y clases medias en el marco del Programa Conectar Igualdad en el Gran La Plata

Fil: Benítez Larghi, Sebastián. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

La inclusión masiva de tecnologías digitales en el ámbito escolar : Un estudio comparativo de la apropiación de TIC por estudiantes de clases populares y clases medias en el marco del Programa Conectar Igualdad en el Gran La Plata

Fil: Benítez Larghi, Sebastián. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

A lectoescrita em alunos surdos a frequentar o ensino bilingue: avaliação da eficácia de um programa de treino

As crianças surdas, integradas num contexto educativo bilingue, aprendem a ler e a escrever numa língua oral-auditiva, língua com caraterísticas diferentes da língua que adquirem naturalmente que é visuo-espacial. A Língua Gestual Portuguesa é a língua materna dos surdos, constituindo-se a Língua Portuguesa, no modo oral e escrito, como a sua segunda língua. Face à escassez de instrumentos facilitadores do desenvolvimento das competências de leitura e escrita em crianças surdas, esta investigação visa avaliar a eficácia do programa de treino da competência lectoescrita para alunos surdos a frequentar o ensino bilingue – Programa PODER. O programa de intervenção concebido desenvolveu-se num processo de investigação-ação e foi aplicado a seis alunos surdos, a frequentar o 2.º ano de escolaridade do ensino básico, numa Escola de Referência para a Educação Bilingue de Alunos Surdos. As respostas obtidas, através de questionários aos alunos surdos (6), foram analisadas qualitativamente. Para medir o índice de legibilidade do texto e a facilidade de leitura, no Pré-teste e no Pós-teste de lectoescrita aplicado aos alunos surdos, utilizou-se o “Índice de Legibilidade de FleschKincaid Grade Level” e o “Índice de Facilidade de Leitura de Flesch” (ambos baseados no comprimento das palavras e das frases). Os resultados obtidos indicam que o Índice de Legibilidade fica situado entre 7,0 e 10,0, o recomendável e o Índice de Facilidade de Leitura enquadra-se no Nível A1 – Utilizador Básico. Os dados afiguram-se expressivos para a validação do programa de treino e prova da sua eficácia, no desenvolvimento da competência lectoescrita de alunos surdos integrados no ensino bilingue. Deste estudo, retiram-se implicações para a intervenção psicoeducacional da lectoescrita junto de alunos surdos que frequentam o ensino bilingue.

O Efeito da Frequência de um Programa de Promoção de Competências Pessoais e Sociais em Crianças Institucionalizadas

A literatura tem evidenciado que as competências pessoais e sociais têm sido relevantes para o desenvolvimento do bem-estar e de um ajustamento psicossocial das crianças e jovens, em geral. É importante estimular os indivíduos a adoptarem uma postura activa, através da aprendizagem de instrumentos para a vida. Os programas que têm como intuito a promoção destas competências, tornam-se fundamentais para que as crianças e jovens cresçam com competências que lhes permitam no futuro, evitar comportamentos disfuncionais e até mesmo acautelar determinadas patologias. Assim, quanto mais cedo a intervenção for realizada, no âmbito das competências sociais e emocionais, mais facilmente o indivíduo reconhece as próprias emoções e as dos outros, desenvolvendo desta forma a habilidade de regular as suas próprias emoções, o que lhes permite também, que num espaço interpessoal possam revelar sentimentos, desejos, opiniões, sempre respeitando os outros, e demonstrando sempre a capacidade de resolução de problemas imediatos, de forma a minimizar a ocorrência de problemas futuros. Neste âmbito desenvolveu-se um estudo quase experimental, do tipo pré e pós teste, sem grupo de controlo, com o objectivo de avaliar o efeito da frequência de um programa de promoção de competências pessoais e sociais ao nível do auto-conceito, da auto-estima, do comportamento assertivo, do efeito de coping e da inteligência emocional. Esta amostra foi constituída por sete crianças do género feminino, com idades compreendidas entre os oito e onze anos de idade institucionalizadas, sendo que todas estas crianças foram submetidas ao programa ―Aprender para Ser‖, o qual foi concebido para treze sessões, tendo durado três meses. Na avaliação final, os resultados revelaram, que as crianças obtiveram melhorias, em todas as dimensões avaliadas, sendo as diferenças estatisticamente significativas ao nível das estratégias de coping (cognitivo-comportamental e activa), comportamento total e agressivo e em todos os resultados dos domínios da inteligência emocional. Isto leva-nos a sugerir a implementação do programa durante mais tempo e a mais crianças para que as competências possam ser desenvolvidas ajudando as crianças a reconhecer, gerir as suas emoções e a apreciarem as perspectivas dos outros, a estabelecendo objectivos positivos, a tomarem decisões responsáveis.